Abstract
The treatment of heart failure has included vasodilators, positive inotropes and most successfully neuro-hormonal blockade. Recent research has looked at metabolic and immune modulatory approaches, and implantable, mainly electrical devices. The near future in pharmacological research for heart failure remains focussed on classic methodologies and small molecules, but despite significant improvements we still know relatively little of the complex interactions in HF particularly for HFpEF.. Pharmacotherapy will in future be combined with advances in biotechnology, nanotechnology and devices and a digital revolution will help us to monitor patients at a distance, using wireless devices. Heart failure research has achieved much over the last 4 decades but the pace of innovation and research has not abated and future advances in this disabling condition are indeed likely.
Highlights
Until the 1970s the only treatments for the management of heart failure were based on bed rest, restriction of physical activity, fluid restriction and pharmacological therapy limited to diuretics and digitalis
The near future in pharmacological research for heart failure remains focussed on classic methodologies and small molecules, but despite significant improvements we still know relatively little of the complex interactions in HF for heart failure with preserved ejection fraction (HFpEF)
The results in heart failure with reduced ejection fraction (HFrEF) from the PARADIGM-HF study, in which a smart fixed dose combination of sacubitril and valsartan (LCZ696) significantly improved prognosis compared with treatment with the ACEi enalapril suggests that there is still room for further developments using this approach, even though other attempts at comprehensive neurohormonal modulation have failed, such as when vaospressin and/or endothelin antagonists were added to the triad of angiotensin converting enzyme inhibitors (ACEIs), BBs and mineralocorticoid receptor antagonists (MRAs)
Summary
Until the 1970s the only treatments for the management of heart failure were based on bed rest, restriction of physical activity, fluid restriction and pharmacological therapy limited to diuretics and digitalis. The near future in pharmacological research for heart failure remains focussed on classic methodologies and small molecules, but despite significant improvements we still know relatively little of the complex interactions in HF for HFpEF.
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